Healthcare Provider Details

I. General information

NPI: 1598854176
Provider Name (Legal Business Name): RICHARD D. ROBLEE DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 E SUNBRIDGE DR
FAYETTEVILLE AR
72703
US

IV. Provider business mailing address

162 E SUNBRIDGE DR
FAYETTEVILLE AR
72703-2830
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-6060
  • Fax: 479-521-4161
Mailing address:
  • Phone: 479-521-6060
  • Fax: 479-521-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3412
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2720
License Number StateAR

VIII. Authorized Official

Name: DR. RICHARD DAVID ROBLEE
Title or Position: OWNER
Credential: DDS, MS
Phone: 479-521-6060